Pain in the heel can have a number of causes, from constantly being on your feet, to arthritis in the heel, to a sports injury. The most common cause of heel pain however, is plantar fasciitis. We interviewed orthopaedic surgeon Mr Matthew Solan to tell us more about heel pain and how to treat plantar fasciitis.
What areas of the heel can suffer pain?
Heel pain can affect the back of the heel, where it is usually related to the Achilles’ tendon. Often there is swelling. Usually this is 3-4cm above the heel bone. The back of the heel bone can also be affected, where the Achilles tendon attaches to the bone. Pain at the back of the heel, however, is less common.
The most common cause of pain underneath the heel is plantar fasciitis (sometimes called Policeman’s Heel). The plantar fascia is a strong ligament (an extension of the Achilles tendon) that supports the arch of your foot. This ligament connects the toes to the heel, and provides stability to the foot as you walk.
Plantar fasciitis is painful because the plantar fascia ligament becomes injured and swollen. Usually this is caused by increased stress on the foot throughout the day. This is aggravated by:
- Natural tightness of the Achilles tendon
- High arches or flat feet
- Rheumatoid arthritis and related complaints
- Impact sports e.g. running
- Being overweight
How can I ease heel pain myself?
The following self-care steps can help the heel to recover:
- Resting the heel
- Weight loss (if you are overweight, this puts greater strain through the arch of the foot)
- Shoes and/or orthotics designed to provide extra support
Painkillers (particularly anti-inflammatory pills) are seldom useful.
When would I need to see a specialist?
Most patients recover from heel pain within a few weeks.
Advice and treatment from a physiotherapist is helpful if the healing progress is slow.
If there is any uncertainty about the cause of the pain, a specialist can assess the heel and if needed use x-rays and scans to provide a clearer diagnosis. After close assessment of the severity of the condition, a treatment plan will be administered.
How does a specialist treat plantar fasciitis?
Firstly, the specialist must confirm that the pain is definitely originating from the plantar fascia.
Other causes of heel pain are rare but they would require very different treatment. This is why it is of utmost importance to make the correct diagnosis.
Stretching, weight loss (if needed) and rest allow most cases of plantar fasciitis to resolve.
A thorough biomechanics assessment can sometimes reveal features that make recovery difficult. Tight calf muscles is one such example. Occasionally, problems such as tight calf muscles require treatment before the heel itself can recover.
Steroid injections to the heel have been popular, but often provide only temporary relief. There are side effects to consider. When used, injections are best performed with a scan or x-ray to ensure accurate placement.
Shockwave therapy is useful to “re-kindle” the body’s healing process. This is a non-invasive treatment delivered in an out-patient clinic. The therapy works by inducing micro trauma to the damaged tissue, which stimulates the body’s natural healing response. The treatment can be uncomfortable. It is recommended to try more traditional treatments for a period of at least 6 months before considering shock wave therapy.
If you have any questions regarding heel pain, and would like to speak with a specialist, please visit Mr Matthew Solan’s Top Doctors profile.